Brazilian guidelines for the management of tuberculosis infection in immune-mediated inflammatory diseases: is retesting in latent tuberculosis screening appropriate and Safe?

Abstract

The article "Brazilian Recommendations for the Management of Tuberculosis Infection in Immune-Mediated Inflammatory Diseases" by Viviane de Souza et al. presents important discussions on the subject; however, the recommendation for annual repetition of the TST/IGRA test for three years and after medication changes raises considerable concerns. This approach may lead to overdiagnosis and overtreatment of latent tuberculosis infection (LTBI). Frequent false-positive results in retests can result in unnecessary antibiotic use, contributing to bacterial resistance, a problem of global significance. The recommendation, considered to have a moderate level of evidence, is subject to criticism. Arguments used to support retesting, such as high conversion rates of tests after one year, reports of tuberculosis cases despite negative screenings being attributed to false negatives, and reliance on other sources with lower levels of evidence, do not constitute sufficient evidence to confirm tuberculosis infection or justify the recommendation. On the other hand, there is evidence that has not been considered in the discussion against the recommendation for retesting, indicating that this practice may increase the risk of diagnosing false-positive infections, leading to overtreatment without clinically proven benefits. Potentially harmful interventions should not be implemented without solid evidence to support them. In this letter to the editor, we briefly discuss this recommendation and the arguments against its implementation, highlighting its associated risks.